Challenges and Forces Driving Adoption Of Health Information Technology and Electronic Healthcare Records

In this segment on Electronic Healthcare records, being sponsored by Physicians Office Resource, we will look at ePrescribing and its effects on your practice
 

Big News: ePrescribing Incentive Finalized!

WHAT IS THE NEWS?

Until now, there have not been standardized incentives across the country for using healthcare information technology.  For many years we have been leading the charge to create incentives as we knew that this was a very important element of driving widespread adoption of the products that we develop.  Which, of course, are not just products, but are real solutions to eliminate medical errors, improve quality and reduce cost.  Well, the work has paid off and that day has finally come : - )

On Friday October 31, 2008, The Centers for Medicare and Medicaid Services (CMS) announced their final ruling on the electronic prescribing incentive portion of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).  Section 132 of the law provides financial incentives for physicians to use electronic prescribing as early as January 1, 2009 and requires adoption or imposes a penalty by 2012.  Whether or not you are involved with ePrescribing, this is a clear signal from the Federal Government that they are willing to explore providing incentives for information technology across the board in the future.  Additional detail is in the article below, but here’s the summary:

WHAT DOES THIS MEAN TO YOU? 

THE BOTTOM LINE IS THAT THIS IS AN AMAZING DECISION …THE AVERGE PHYSICIAN WILL RECEIVE AN ROI OF $3,000 TO $4,000 PER YEAR (OR $15,000 TO $20,000 INCREMENTALLY OVER THE NEXT 5 YEARS)!!!  BE THE EXPERT, SHARE THE NEWS!!!

• What you have to do to qualify for eRx and CMS qualified electronic prescribing. Solutions must be able to do:
1. Generate a medication list
2. Select medications, transmit prescriptions electronically and conduct safety checks
3. Provide information on lower cost alternatives
4. Provide information on formulary or tiered formulary medications, patient eligibility and authorization requirements received electronically from the patient’s drug plan

 WHAT DOES THIS INCENTIVE MEAN FOR PHYSICIANS? WHAT IS THE PROJECTED NET GAIN FROM THESE INCENTIVES?
ePrescribing Forecast Model 
 
Patients/Day 24
% of Practice Medicare 33%
Medicare Patients/Day 8
 
Revenue/Medicare Patient $85
Days/Year 250
 
Medicare Revenue/Year $170,000
 
% increase in 2009 2%
 
Incremental Revenue for ePrescribing/MD/Year $3,400

So the Message is Clear:  $3400 per year is a solid motivator for any physician to jump on board.  Additionally, as noted above, physicians who do not use the technology would see their payments cut by 1% in 2012 and a maximum of up to 2% for 2014 and beyond.

HOW DO CLIENTS RECEIVE THEIR INCENTIVE PAYMENT?

• Reporting periods are defined as one year in length and the incentive is based on the covered professional services furnished by the eligible professional during the reporting year. Payment will be received approximately two (2) months after the reporting period
 

• Eligible professionals (reporting on at least 50% of eligible patients) must use a CMS qualified application.  In other words,  the system must be able to: 1) Generate a medication list, 2) select medications, transmit prescriptions electronically and conduct safety checks, 3) provide information on lower cost alternatives and 4) provide information on formulary or tiered formulary medications, patient eligibility and authorization requirements received electronically from the patient’s drug plan
 

• Reporting is based on one of three (3) G-codes entered on Superbills. Note: One (1) of these codes must be entered every time a provider sees a Medicare patient – whether or not he prescribes a medication
o All prescriptions were sent electronically (G8443)
o No prescriptions were written (G-code must still be entered) (G8445)
o Didn’t write them electronically due to an exemption (i.e. pt. request, controlled substances, etc.) (G8446)
 

• Fee reduction is prospective:  providers have to electronically prescribe by a date TBD in 2010 to be sure their fees are not reduced in 2012

ARE THERE OTHER INCENTIVES?

In addition to the e-prescribing incentive, physicians who successfully report measures under the Physician Quality Reporting Initiative will be eligible for an additional 2% incentive payment (so, coupled with the ePrescribing incentive, that is an additional 4%!). Also, CMS will implement a 1.1% Medicare fee schedule increase as required under the Medicare Improvements for Patients and Providers Act of 2008.

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Friday, October 31, 2008
CMS Offers Details of Electronic Prescribing Incentive Program

CMS issued a final rule establishing an incentive program for health care providers who adopt and use electronic prescribing systems, Health IT Strategist reports (Lubell, Health IT Strategist, 10/31).
 

Physicians and other clinicians participating in Medicare who adopt and use qualified e-prescribing systems could earn an incentive payment of 2% of their total Medicare-allowed charges during 2009.
 

Eligible physicians must use an e-prescribing system that can:

• Communicate with patients' pharmacies;
• Generate alerts about possible adverse events, such as drug interactions, improper dosing and allergy concerns; and
• Help physicians identify appropriate drugs and provide information on lower cost options (Monegain, Healthcare IT News, 10/31).
The final rule will be published Nov. 19 in the Federal Register, and comments will be accepted until Dec. 29.
 

Other Medicare Payment Increases

In addition to the e-prescribing incentive, physicians who successfully report measures under the Physician Quality Reporting Initiative will be eligible for a 2% incentive payment. Also, CMS will implement a 1.1% Medicare fee schedule increase as required under the Medicare Improvements for Patients and Providers Act of 2008 (Health Data Management, 10/31).